title: Femoral and vertebral strength improvements in postmenopausal women with osteoporosis treated with denosumab.
abstract: In the randomized, placebo-controlled FREEDOM study of women aged 60 to 90 years with postmenopausal osteoporosis, treatment with denosumab once every 6 months for 36 months significantly reduced hip and new vertebral fracture risk by 40% and 68%, respectively. To gain further insight into this efficacy, we performed a nonlinear finite element analysis (FEA) of hip and spine quantitative computed tomography (QCT) scans to estimate hip and spine strength in a subset of FREEDOM subjects (n = 48 placebo; n = 51 denosumab) at baseline, 12, 24, and 36 months. We found that, compared with baseline, the finite element estimates of hip strength increased from 12 months (5.3%; p < 0.0001) and through 36 months (8.6%; p < 0.0001) in the denosumab group. For the placebo group, hip strength did not change at 12 months and decreased at 36 months (-5.6%; p < 0.0001). Similar changes were observed at the spine: strength increased by 18.2% at 36 months for the denosumab group (p < 0.0001) and decreased by -4.2% for the placebo group (p = 0.002). At 36 months, hip and spine strength increased for the denosumab group compared with the placebo group by 14.3% (p < 0.0001) and 22.4% (p < 0.0001), respectively. Further analysis of the finite element models indicated that strength associated with the trabecular bone was lost at the hip and spine in the placebo group, whereas strength associated with both the trabecular and cortical bone improved in the denosumab group. In conclusion, treatment with denosumab increased hip and spine strength as estimated by FEA of QCT scans compared with both baseline and placebo owing to positive treatment effects in both the trabecular and cortical bone compartments. These findings provide insight into the mechanism by which denosumab reduces fracture risk for postmenopausal women with osteoporosis.
authors.affiliation: University of California Berkeley, Berkeley, CA, USA; O.N. Diagnostics, Berkeley, CA, USA.
authors.forename: Tony M
authors.initials: TM
authors.lastname: Keaveny
authors.forename: Michael R
authors.initials: MR
authors.lastname: McClung
authors.forename: Harry K
authors.initials: HK
authors.lastname: Genant
authors.forename: Jose R
authors.initials: JR
authors.lastname: Zanchetta
authors.forename: David
authors.initials: D
authors.lastname: Kendler
authors.forename: Jacques P
authors.initials: JP
authors.lastname: Brown
authors.forename: Stefan
authors.initials: S
authors.lastname: Goemaere
authors.forename: Chris
authors.initials: C
authors.lastname: Recknor
authors.forename: Maria L
authors.initials: ML
authors.lastname: Brandi
authors.forename: Richard
authors.initials: R
authors.lastname: Eastell
authors.forename: David L
authors.initials: DL
authors.lastname: Kopperdahl
authors.forename: Klaus
authors.initials: K
authors.lastname: Engelke
authors.forename: Thomas
authors.initials: T
authors.lastname: Fuerst
authors.forename: Hoi-Shen
authors.initials: HS
authors.lastname: Radcliffe
authors.forename: Cesar
authors.initials: C
authors.lastname: Libanati
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D001696:Biomechanical Phenomena / Q000187:drug effects; D000069448:Denosumab; D005260:Female; D020342:Finite Element Analysis; D006615:Hip / Q000000981:diagnostic imaging; D006801:Humans; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy*; D017698:Postmenopause; D013131:Spine / Q000000981:diagnostic imaging / Q000187:drug effects; D014057:Tomography, X-Ray Computed
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000069448:Denosumab
keywords: DENOSUMAB; FINITE ELEMENT ANALYSIS; HIP STRENGTH; OSTEOPOROSIS; SPINE STRENGTH